This document discusses soft tissue sarcomas (STS), including:
- Incidence rates in the US and Egypt. Radiation therapy is a risk factor.
- Common primary and metastatic sites vary by tumor type.
- STS originate from mesenchymal cells and include many subtypes.
- Diagnosis involves biopsy, imaging, and genetic testing to identify specific mutations in certain sarcoma subtypes.
- Treatment depends on grade and stage but commonly involves surgery with or without chemotherapy and/or radiation therapy. Outcomes vary significantly by histology, grade, and other factors.
Soft tissue sarcomas are rare mesenchymal tumors that can arise in various soft tissues of the body. They are classified based on their cell of origin and differentiation. Treatment involves surgical excision with negative margins, with adjuvant radiation therapy sometimes used to improve local control. Prognosis depends on tumor size, grade, depth and margins of resection, with retroperitoneal and high grade tumors having a worse prognosis due to difficulty obtaining clear margins. Metastatic disease typically spreads to the lungs and has a poor median survival of 8-12 months.
Soft tissue sarcomas, treatment (surgical, radiation, chemotherapy)Joseph A. Di Como MD
This document discusses soft tissue sarcomas (STS), a rare type of cancer that arises in connective tissues like muscles or fat. It notes that STS account for about 1% of adult cancers in the US, with most occurring in extremities or trunk. Risk factors include radiation exposure, certain chemicals, and genetic conditions. STS are classified and graded based on cell type and differentiation. Treatment typically involves surgical resection with clear margins, sometimes combined with radiation or chemotherapy depending on stage, grade, and location. Prognosis depends on stage and grade, with 5-year survival rates ranging from 54-65% after complete resection of primary retroperitoneal sarcomas.
Soft tissue sarcomas are a heterogeneous group of malignant tumors that arise from connective tissues. They constitute 1% of adult cancers but 15% of childhood cancers. The overall 5-year survival rate is 50-60%. Surgery involving wide local excision is the main treatment, with the goal of achieving clear margins while preserving function when possible. For high-grade or large tumors, adjuvant radiation therapy and chemotherapy may be recommended to reduce the risk of recurrence or metastasis. Prognosis depends on the histological subtype, grade, size and extent of the primary tumor.
- Sentinel lymph node biopsy (SLNB) is an important prognostic factor in breast cancer as it allows detection of cancer spread to axillary lymph nodes.
- SLNB is recommended for early-stage T1-T2 tumors without clinically detectable lymph node involvement but is not recommended for larger T3-T4 tumors or inflammatory breast cancer.
- SLNB accuracy can be improved to over 90% by using blue dye mapping and radioisotope tracing techniques together. A negative SLNB result can spare patients from additional axillary lymph node dissection but a positive result may require further treatment.
This document provides information on staging and treatment for carcinoma of the esophagus. It begins with an overview of the AJCC TNM classification system and staging for squamous cell carcinoma and adenocarcinoma. Diagnostic workup is discussed including endoscopy, CT, EUS, PET and other imaging. Treatment options described are surgery, chemotherapy, and radiotherapy including techniques for external beam radiotherapy and brachytherapy. Several trials evaluating preoperative and postoperative radiotherapy are summarized.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Soft tissue sarcomas are rare mesenchymal tumors that can arise in various soft tissues of the body. They are classified based on their cell of origin and differentiation. Treatment involves surgical excision with negative margins, with adjuvant radiation therapy sometimes used to improve local control. Prognosis depends on tumor size, grade, depth and margins of resection, with retroperitoneal and high grade tumors having a worse prognosis due to difficulty obtaining clear margins. Metastatic disease typically spreads to the lungs and has a poor median survival of 8-12 months.
Soft tissue sarcomas, treatment (surgical, radiation, chemotherapy)Joseph A. Di Como MD
This document discusses soft tissue sarcomas (STS), a rare type of cancer that arises in connective tissues like muscles or fat. It notes that STS account for about 1% of adult cancers in the US, with most occurring in extremities or trunk. Risk factors include radiation exposure, certain chemicals, and genetic conditions. STS are classified and graded based on cell type and differentiation. Treatment typically involves surgical resection with clear margins, sometimes combined with radiation or chemotherapy depending on stage, grade, and location. Prognosis depends on stage and grade, with 5-year survival rates ranging from 54-65% after complete resection of primary retroperitoneal sarcomas.
Soft tissue sarcomas are a heterogeneous group of malignant tumors that arise from connective tissues. They constitute 1% of adult cancers but 15% of childhood cancers. The overall 5-year survival rate is 50-60%. Surgery involving wide local excision is the main treatment, with the goal of achieving clear margins while preserving function when possible. For high-grade or large tumors, adjuvant radiation therapy and chemotherapy may be recommended to reduce the risk of recurrence or metastasis. Prognosis depends on the histological subtype, grade, size and extent of the primary tumor.
- Sentinel lymph node biopsy (SLNB) is an important prognostic factor in breast cancer as it allows detection of cancer spread to axillary lymph nodes.
- SLNB is recommended for early-stage T1-T2 tumors without clinically detectable lymph node involvement but is not recommended for larger T3-T4 tumors or inflammatory breast cancer.
- SLNB accuracy can be improved to over 90% by using blue dye mapping and radioisotope tracing techniques together. A negative SLNB result can spare patients from additional axillary lymph node dissection but a positive result may require further treatment.
This document provides information on staging and treatment for carcinoma of the esophagus. It begins with an overview of the AJCC TNM classification system and staging for squamous cell carcinoma and adenocarcinoma. Diagnostic workup is discussed including endoscopy, CT, EUS, PET and other imaging. Treatment options described are surgery, chemotherapy, and radiotherapy including techniques for external beam radiotherapy and brachytherapy. Several trials evaluating preoperative and postoperative radiotherapy are summarized.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
Management of Testicular Cancers document provides an overview of testicular cancer including:
- Epidemiology showing highest rates in Western countries and increasing worldwide incidence. India has a low incidence of 0.5 cases per 100,000 men.
- Risk factors include cryptorchidism, family history, and genetic conditions. Germ cell tumors are the most common type.
- Staging uses AJCC TNM system and International Germ Cell Consensus Classification for metastatic disease.
- For stage I seminoma, surveillance is an option but adjuvant radiotherapy to para-aortic region is still commonly used with dog leg fields showing similar outcomes to para-aortic fields alone and reducing toxicity
1. Retroperitoneal tumors are rare and often malignant, with liposarcoma and leiomyosarcoma being the most common.
2. They typically present as large abdominal masses without symptoms until they compress nearby structures.
3. CT scan is the main imaging method used to identify the tumor type, size, and involvement of surrounding organs.
4. Surgical resection is the primary treatment when possible, though radiation and chemotherapy may be used as adjuvants or for advanced disease. Prognosis depends on tumor grade, size, and whether a complete resection can be achieved.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Osteosarcoma is the most common primary bone cancer, often arising in the appendicular skeleton of teenagers and young adults. It is typically a high grade tumor associated with rapid bone proliferation and spread. Treatment involves complete surgical resection with limb-sparing surgery when possible, along with chemotherapy both before and after surgery. Radiation therapy may be used for unresectable or incompletely resected tumors. Prognostic factors include tumor size, location of metastases, and response to preoperative chemotherapy. While survival has improved with modern multimodal treatment, new strategies are still needed given the risk of recurrence and lung metastases.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
This document summarizes the management of early breast cancer and carcinoma in situ. It discusses the stages included in early breast cancer and factors that influence treatment decisions such as stage, nodal status, tumor characteristics, age, and patient preference. The main treatment options for the primary tumor and axilla are discussed, including surgery, radiotherapy, chemotherapy, hormonal therapy, and targeted therapy. Breast conservation therapy with lumpectomy or quadrantectomy followed by radiotherapy is an acceptable alternative to mastectomy for early stage breast cancer based on evidence from multiple clinical trials showing equivalent survival outcomes.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
1. Testicular cancer is most common in young men aged 20-40 years and 90-95% are germ cell tumors.
2. Survival rates have improved to over 95% for stage I and II seminomas and 90% for stage I non-seminomas due to better understanding of the disease, use of tumor markers, and cisplatin chemotherapy.
3. Treatment involves radical orchidectomy followed by radiotherapy for seminomas or lymph node dissection/chemotherapy for non-seminomas depending on stage.
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document outlines the radiotherapy planning process for pituitary adenoma. It discusses indications for radiotherapy including when medical therapy fails or tumors cause vision problems or compression symptoms. Key steps include pre-radiotherapy evaluation with endocrine and visual assessments, immobilization using customized masks, imaging with CT and MRI to delineate targets and organs at risk, target delineation of GTV, CTV and PTV, dose prescription to targets and nearby structures, and follow up to monitor treatment response and outcomes. The goal of radiotherapy is to control tumor growth and hormone production while minimizing damage to surrounding normal tissues.
Management of renal cell carcinoma and wilms' tumor Anil Gupta
This document provides an overview of the management of renal tumors. It discusses the classification, epidemiology, clinical presentation, diagnostic evaluation, staging, and management of both localized and locally advanced renal cell carcinoma. For localized RCC, treatment options include radical or partial nephrectomy, which can be performed openly, laparoscopically, or robotically. Active surveillance is also discussed. For locally advanced RCC, the aim is complete excision though extended surgery may be needed. Neoadjuvant radiotherapy has not proven beneficial.
Radio Frequency Ablation (RFA Treatment ) -Modern Technology for management l...SafeMedTrip
Safemedtrip india's number one company of medical treatment, which provide low cost treatment package for international patient. if you have any problem Please scan and email your medical reports to us at hospitalindia@gmail.com or help@safemedtrip.com or call us at +91-9899993637 and we shall get you a Free, No Obligation Opinion from India's leading Specialist Doctors.
This document summarizes information about anal cancer, including epidemiology, risk factors, staging, histology, and treatment approaches. It notes that anal cancer accounts for about 2% of gastrointestinal cancers. Risk factors include HPV, HIV/AIDS, and receptive anal intercourse. Treatment typically involves chemoradiation with 5-FU and mitomycin C, which results in high response rates. Additional trials have explored optimal radiation doses and chemotherapy regimens.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
This document discusses evidence-based management of rectal malignancy. It provides an overview of preoperative staging for rectal cancer, TNM staging criteria, the importance of total mesorectal excision surgery, and the role of adjuvant radiation therapy and chemotherapy based on randomized controlled trials. For locally advanced rectal cancer, it reviews evidence that preoperative radiation therapy with chemotherapy provides benefits of downstaging and reduced local recurrence compared to postoperative treatment.
This document discusses updates to the WHO classification of meningiomas and management strategies based on grade.
The key points are:
1. The WHO 5th edition emphasizes applying criteria for atypical (grade 2) and anaplastic (grade 3) regardless of subtype. Chordoid and clear cell subtypes are now grade 2 due to higher recurrence.
2. Molecular biomarkers like SMARCE1, BAP1, KLF4/TRAF7 mutations are associated with classification and grading. TERT promoter mutations and CDKN2A/B deletions qualify a meningioma as grade 3.
3. Management depends on grade and extent of resection. Grade 1 tumors may
This document discusses soft tissue tumors. It defines soft tissue and describes its composition. It notes that soft tissue tumors can be caused by radiation, burns, trauma, viruses, or genetic syndromes. The document outlines various tumor types including liposarcomas, fibrosarcomas, and malignant fibrous histiocytomas. It describes histologic patterns seen in different tumors and discusses grading systems. Pseudosarcomas like nodular fasciitis are also summarized.
Soft tissue sarcomas are rare cancers that arise from connective tissues. They most commonly occur in the extremities and abdominal cavity. Diagnosis involves biopsy and imaging such as MRI or CT. Treatment is primarily surgical resection with clear margins, sometimes combined with radiation therapy or chemotherapy. Prognostic factors include tumor size, grade, and margin status. Complete surgical removal with negative margins improves local control and survival outcomes for soft tissue sarcomas.
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
Management of Testicular Cancers document provides an overview of testicular cancer including:
- Epidemiology showing highest rates in Western countries and increasing worldwide incidence. India has a low incidence of 0.5 cases per 100,000 men.
- Risk factors include cryptorchidism, family history, and genetic conditions. Germ cell tumors are the most common type.
- Staging uses AJCC TNM system and International Germ Cell Consensus Classification for metastatic disease.
- For stage I seminoma, surveillance is an option but adjuvant radiotherapy to para-aortic region is still commonly used with dog leg fields showing similar outcomes to para-aortic fields alone and reducing toxicity
1. Retroperitoneal tumors are rare and often malignant, with liposarcoma and leiomyosarcoma being the most common.
2. They typically present as large abdominal masses without symptoms until they compress nearby structures.
3. CT scan is the main imaging method used to identify the tumor type, size, and involvement of surrounding organs.
4. Surgical resection is the primary treatment when possible, though radiation and chemotherapy may be used as adjuvants or for advanced disease. Prognosis depends on tumor grade, size, and whether a complete resection can be achieved.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Osteosarcoma is the most common primary bone cancer, often arising in the appendicular skeleton of teenagers and young adults. It is typically a high grade tumor associated with rapid bone proliferation and spread. Treatment involves complete surgical resection with limb-sparing surgery when possible, along with chemotherapy both before and after surgery. Radiation therapy may be used for unresectable or incompletely resected tumors. Prognostic factors include tumor size, location of metastases, and response to preoperative chemotherapy. While survival has improved with modern multimodal treatment, new strategies are still needed given the risk of recurrence and lung metastases.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
This document summarizes the management of early breast cancer and carcinoma in situ. It discusses the stages included in early breast cancer and factors that influence treatment decisions such as stage, nodal status, tumor characteristics, age, and patient preference. The main treatment options for the primary tumor and axilla are discussed, including surgery, radiotherapy, chemotherapy, hormonal therapy, and targeted therapy. Breast conservation therapy with lumpectomy or quadrantectomy followed by radiotherapy is an acceptable alternative to mastectomy for early stage breast cancer based on evidence from multiple clinical trials showing equivalent survival outcomes.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
1. Testicular cancer is most common in young men aged 20-40 years and 90-95% are germ cell tumors.
2. Survival rates have improved to over 95% for stage I and II seminomas and 90% for stage I non-seminomas due to better understanding of the disease, use of tumor markers, and cisplatin chemotherapy.
3. Treatment involves radical orchidectomy followed by radiotherapy for seminomas or lymph node dissection/chemotherapy for non-seminomas depending on stage.
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document outlines the radiotherapy planning process for pituitary adenoma. It discusses indications for radiotherapy including when medical therapy fails or tumors cause vision problems or compression symptoms. Key steps include pre-radiotherapy evaluation with endocrine and visual assessments, immobilization using customized masks, imaging with CT and MRI to delineate targets and organs at risk, target delineation of GTV, CTV and PTV, dose prescription to targets and nearby structures, and follow up to monitor treatment response and outcomes. The goal of radiotherapy is to control tumor growth and hormone production while minimizing damage to surrounding normal tissues.
Management of renal cell carcinoma and wilms' tumor Anil Gupta
This document provides an overview of the management of renal tumors. It discusses the classification, epidemiology, clinical presentation, diagnostic evaluation, staging, and management of both localized and locally advanced renal cell carcinoma. For localized RCC, treatment options include radical or partial nephrectomy, which can be performed openly, laparoscopically, or robotically. Active surveillance is also discussed. For locally advanced RCC, the aim is complete excision though extended surgery may be needed. Neoadjuvant radiotherapy has not proven beneficial.
Radio Frequency Ablation (RFA Treatment ) -Modern Technology for management l...SafeMedTrip
Safemedtrip india's number one company of medical treatment, which provide low cost treatment package for international patient. if you have any problem Please scan and email your medical reports to us at hospitalindia@gmail.com or help@safemedtrip.com or call us at +91-9899993637 and we shall get you a Free, No Obligation Opinion from India's leading Specialist Doctors.
This document summarizes information about anal cancer, including epidemiology, risk factors, staging, histology, and treatment approaches. It notes that anal cancer accounts for about 2% of gastrointestinal cancers. Risk factors include HPV, HIV/AIDS, and receptive anal intercourse. Treatment typically involves chemoradiation with 5-FU and mitomycin C, which results in high response rates. Additional trials have explored optimal radiation doses and chemotherapy regimens.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
This document discusses evidence-based management of rectal malignancy. It provides an overview of preoperative staging for rectal cancer, TNM staging criteria, the importance of total mesorectal excision surgery, and the role of adjuvant radiation therapy and chemotherapy based on randomized controlled trials. For locally advanced rectal cancer, it reviews evidence that preoperative radiation therapy with chemotherapy provides benefits of downstaging and reduced local recurrence compared to postoperative treatment.
This document discusses updates to the WHO classification of meningiomas and management strategies based on grade.
The key points are:
1. The WHO 5th edition emphasizes applying criteria for atypical (grade 2) and anaplastic (grade 3) regardless of subtype. Chordoid and clear cell subtypes are now grade 2 due to higher recurrence.
2. Molecular biomarkers like SMARCE1, BAP1, KLF4/TRAF7 mutations are associated with classification and grading. TERT promoter mutations and CDKN2A/B deletions qualify a meningioma as grade 3.
3. Management depends on grade and extent of resection. Grade 1 tumors may
This document discusses soft tissue tumors. It defines soft tissue and describes its composition. It notes that soft tissue tumors can be caused by radiation, burns, trauma, viruses, or genetic syndromes. The document outlines various tumor types including liposarcomas, fibrosarcomas, and malignant fibrous histiocytomas. It describes histologic patterns seen in different tumors and discusses grading systems. Pseudosarcomas like nodular fasciitis are also summarized.
Soft tissue sarcomas are rare cancers that arise from connective tissues. They most commonly occur in the extremities and abdominal cavity. Diagnosis involves biopsy and imaging such as MRI or CT. Treatment is primarily surgical resection with clear margins, sometimes combined with radiation therapy or chemotherapy. Prognostic factors include tumor size, grade, and margin status. Complete surgical removal with negative margins improves local control and survival outcomes for soft tissue sarcomas.
Los sarcomas son tumores que surgen a partir de células del mesodermo, se localizan principalmente en extremidades y retroperitoneo, y se dividen en sarcomas de tejido blando y osteosarcomas. Su cuadro clínico incluye inflamación sin dolor y presencia de masas duras, y el diagnóstico se basa en imagenología, biopsia y evaluar la extensión del tumor. El tratamiento consiste en resección quirúrgica del tumor, quimioterapia y amputación de extremidades en algunos casos
This document provides information about soft tissue tumors. It discusses the epidemiology, classification, etiology, diagnosis and treatment of both benign and malignant soft tissue tumors. Some key points include:
- Benign soft tissue tumors are more common than sarcomas. Common benign tumors include lipomas, schwannomas and giant cell tumors of the tendon sheath.
- Risk factors for soft tissue sarcoma include exposure to herbicides/pesticides, radiation exposure, genetic conditions and viral infections.
- MRI is usually the best imaging modality for evaluating soft tissue tumors. Biopsy is needed for diagnosis.
- Treatment depends on whether the tumor is benign or malignant. Benign tumors may
This document provides information on bone tumors and osteosarcoma. It begins with an overview of normal bone anatomy and classifications of bone tumors. It then focuses on osteosarcoma, discussing its epidemiology, etiology, pathophysiology, clinical presentation, diagnostic workup, staging systems, and management. Management involves surgical resection with the goal of limb salvage when possible, as well as pre-operative and post-operative chemotherapy typically involving high-dose methotrexate and other drugs. Response to chemotherapy helps determine prognosis, and radiotherapy may have a limited palliative role.
Alberto Pappo, MD, St. Jude Children’s Hospital, Memphis TN
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio. October 2010.
This document discusses the case of Elli, a 6-year old Rottweiler presenting with lameness in the left hindlimb for several months. On examination, Elli had a firm swelling on her distal left tibia and was lame on that leg. Radiographs and tests found no abnormalities except for the swelling. The main differential diagnosis was osteosarcoma, which is the most common bone tumor in dogs. Elli underwent amputation of the affected leg and is being treated with chemotherapy using carboplatin to treat the osteosarcoma and prevent metastases. Osteosarcoma has a poor long-term prognosis, but treatment can potentially extend life for 11 months on average.
The document discusses retroperitoneal sarcomas, which arise in the retroperitoneal space bounded by various structures. Retroperitoneal sarcomas account for 15% of soft tissue sarcomas and one third of malignant retroperitoneal tumors. They can be challenging to manage due to late presentation, nonspecific symptoms, proximity to vital structures, and large size. Common histologic subtypes include liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Diagnosis involves CT, MRI, biopsy. Surgical resection remains the primary treatment when possible.
This is a powerpoint(case presentation) for radiology and imaging resident.There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
This document provides an overview of osteosarcoma, including its definition, epidemiology, pathogenesis, clinical presentation, evaluation, treatment, and subtypes. Osteosarcoma is the second most common primary bone tumor arising from mesenchymal cells. It most often affects people between 12-25 years old. Evaluation involves imaging like x-rays and MRI to determine tumor extent and biopsy for diagnosis. Treatment is typically neoadjuvant chemotherapy followed by surgical resection with wide margins and reconstruction. Prognosis has improved with current multimodal treatment approaches.
Bone tumors can be primary, originating in bone tissue, or secondary/metastatic tumors that have spread from other sites. There are several staging systems for classifying bone tumors, including the Musculoskeletal Tumor Society (MSTS) or Enneking System and the American Joint Committee on Cancer (AJCC) System. The MSTS system classifies benign tumors on a scale of 1-3 based on activity level and defines malignant tumors using Roman numerals based on grade and tumor compartments. The AJCC system incorporates tumor grade, size, lymph node and distant metastasis in its classification. Accurate staging is important for determining prognosis, treatment planning, and comparing outcomes across studies.
Este documento describe los tumores del estroma gastrointestinal (GIST), los cuales se originan de las células madre que se diferencian a células intersticiales de Cajal. Los GIST representan el 2% de los tumores gastrointestinales y ocurren con más frecuencia entre las 4a y 6a décadas de vida. El diagnóstico se realiza mediante biopsia e inmunohistoquímica para marcadores como CD117. El tratamiento principal es la resección quirúrgica completa, aunque también existen opciones de tratamiento médico con inhibidores de
Los tumores del estroma gastrointestinal (GIST) son sarcomas poco comunes que se originan de las células marcapaso en la pared del tracto gastrointestinal. Se caracterizan por ser tumores submucosos que expresan la proteína KIT. El tratamiento para GIST localizado es la cirugía, mientras que para GIST metastásico o localmente avanzado la opción es el tratamiento con imatinib, un inhibidor de la tirosina quinasa del receptor KIT. La supervivencia de pacientes con GIST ha mejorado significativamente con el descubrimiento e implementación del
O documento discute o tumor estromal gastrointestinal (GIST), incluindo sua localização, causas, sintomas, diagnóstico e tratamentos. O GIST começa nas células do sistema nervoso que regulam a digestão e pode ocorrer em qualquer parte do trato gastrointestinal. Os principais tratamentos incluem cirurgia para remover o tumor, terapia alvo com medicamentos e estudos de novos tratamentos.
บรรยายในการประชุมวิชาการ Korat Hand and Reconstructive Surgery Day ครั้งที่ 3 "Update for Musculoskeletal Problems in Upper Extremities"
วันศุกร์ที่ 16 ธันวาคม 2559 ณ ห้องประชุมหลวงพ่อพุธ ฐานิโย อาคารเฉลิมพระเกีบรติ โรงพยาบาลมหาราชนครราชสีมา
Pitfalls in diagnosis of soft tissue tumors of childhoodSonic V S
The document discusses several potential pitfalls in the diagnosis of soft tissue tumors in children. It covers:
1) Misclassification of specific sarcomas like rhabdomyosarcoma subtypes and non-rhabdomyosarcoma soft tissue sarcomas.
2) Benign lesions that can be misdiagnosed as sarcomas, and sarcomas that can be misdiagnosed as benign.
3) Misgrading the aggressiveness of sarcomas.
4) Non-soft tissue tumors that are sometimes misdiagnosed as soft tissue sarcomas. Careful histology, immunohistochemistry, cytogenetics and molecular analysis are needed to arrive at
Soft tissue lesions can present in various forms and require careful examination and description. Skin cancer is the most common cancer type, with over 1 million cases diagnosed yearly in the US. The two main types are melanoma, which causes most skin cancer deaths, and nonmelanoma skin cancers like basal cell and squamous cell carcinoma. Oral and pharyngeal cancers also present risks, with over 30,000 cases yearly and 25% of oral cancer patients dying from the disease. Soft tissue lesions should be carefully examined and described based on location, border, color, configuration and other traits to aid in diagnosis and treatment.
This document discusses sarcomas from a surgical perspective. It defines sarcomas as heterogeneous tumors originating from mesoderm or ectoderm. The most common sarcoma subtypes are pleomorphic sarcoma, gastrointestinal stromal tumor, liposarcoma, and leiomyosarcoma. Sarcomas most often occur in extremities, trunk, and retroperitoneum. Diagnosis involves imaging like MRI or CT along with biopsy. Treatment typically involves surgical resection with negative margins, with chemotherapy or radiation used adjuvantly depending on risk factors. Prognosis depends on factors like size, grade, and margin status.
This document provides a flowchart outlining the management of head and neck cancers. It discusses investigations, pathology testing, staging, pre-treatment assessments, general treatment considerations including multi-modality treatment for stage III/IV cancers, choice of treatment modalities including surgery, radiotherapy and chemotherapy. It provides details on the management of primary tumors and neck nodes, indications for adjuvant treatment, radiotherapy techniques and doses.
This document presents a case presentation on salivary gland tumors. It outlines the investigations, staging, management, and prognosis of salivary gland tumors. The key investigations discussed are history and physical exam, ultrasound with fine needle aspiration, MRI, and histological diagnosis. Surgical management is the primary treatment and may include parotidectomy or neck dissection. Adjuvant radiation therapy can improve outcomes for high-grade or advanced tumors. Definitive radiation is an option for unresectable tumors. Prognosis depends on factors like tumor site, grade, and stage. Sequelae of treatment include facial nerve damage and xerostomia.
This document provides information on the management of gastric cancer, including:
1. Staging of gastric cancer using the TNM system, from Tis to T4 and Stage 0 to Stage IV.
2. Treatment modalities for gastric cancer including surgery, chemotherapy, radiation therapy, and targeted therapy.
3. Factors that influence prognosis such as tumor extent, lymph node involvement, and patient performance status.
4. Guidelines for surgical procedures, lymphadenectomy, radiation therapy targets and fields, and the role of neoadjuvant and adjuvant treatments.
The most common type of cancer arising in the kidney: Renal cell carcinoma(RCC)(also known as Hypernephroma or Grawitz tumor).
Renal cell carcinoma accounts for over 3% of all adult malignancies and has several histological subtypes.
Approximately 85% of kidney tumors are renal cell carcinoma, and approximately 70% of these have a Clear cell histology. Its diagnostic work-up, staging and management.
This document outlines the staging and treatment indications for bladder cancer. It discusses the tumor, node, metastasis (TNM) staging system and provides indications for diagnostic tests like cystoscopy, CT urography, and urine cytology based on the clinical scenario and staging. Treatment indications are provided for non-invasive, muscle-invasive, metastatic, and squamous cell bladder cancers based on tumor stage including options like transurethral resection, chemotherapy, radiation, immunotherapy, surgery, and more. The goal is to understand bladder cancer staging and provide the appropriate treatment based on indications.
1. The document discusses the management of medullary thyroid carcinoma, including clinical presentation, workup, risk stratification, treatment for localized and metastatic disease, and disease monitoring.
2. Treatment involves total thyroidectomy with neck dissection, followed by monitoring of serum calcitonin and CEA levels. For recurrent or persistent disease, options include surgery, radiation, ablation procedures, or systemic therapy with targeted drugs.
3. Recent advances include use of peptide receptor radionuclide therapy using radiolabeled somatostatin analogues, with the addition of radiosensitizing agents improving outcomes.
Management of medullary carcinoma of thyroid - based on latest NCCN and ATA g...Sana Sali
Flow charts with recommendations for Management of medullary carcinoma of thyroid based on latest NCCN guidelines and ATA guidelines. Recent Advances in management included.
This document summarizes soft tissue sarcomas (STS), a rare type of cancer. It discusses that STS can occur anywhere in the body and there are over 100 subtypes. Surgery is the main treatment but chemotherapy and radiation therapy may also be used. Prognosis depends on factors like tumor size, grade, and whether it has metastasized. Recurrence is common and occurs in up to 50% of cases. Specific types discussed include gastrointestinal stromal tumor (GIST) and retroperitoneal sarcomas, which have poorer outcomes compared to extremity STS. Liposarcoma and leiomyosarcoma are two of the most common STS subtypes.
Management principles of soft tissue sarcomaSACHINS700327
This document provides information on the management of soft tissue sarcoma, including epidemiology, pathology, etiology, clinical manifestations, diagnosis, staging, prognostic factors, and treatment options. It discusses that soft tissue sarcomas most commonly occur in the extremities, with the three most common histologic types being undifferentiated pleomorphic sarcomas, liposarcomas, and leiomyosarcomas. The mainstay of treatment is surgery, with the goal of wide excision and negative margins. For high grade tumors, radiation therapy is often recommended pre- or post-operatively to improve local control. Treatment requires a multidisciplinary approach and careful consideration of tumor factors, margins, and functional outcomes
This document provides information on the investigations, management, surgery, radiotherapy, chemotherapy, and treatment algorithm for gastric cancer. It discusses the role of endoscopy, CT, EUS, PET/CT, MRI, and laparoscopic staging in evaluating gastric cancer. It describes the principles and types of surgery, including endoscopic mucosal resection, gastrectomy, and lymph node dissection. It outlines the evidence for adjuvant radiotherapy and chemoradiotherapy post-operatively. It also discusses chemotherapy regimens for locally advanced and metastatic gastric cancer.
This document discusses the definition and treatment of locally advanced rectal cancers. Key points include:
- Locally advanced rectal cancers are defined as T4 or node-positive lesions that cannot be fully resected without a high risk of residual disease.
- Standard MR protocols for rectal imaging include T2-weighted sequences in sagittal, axial, and oblique planes with 1-3mm slice thicknesses.
- Treatment recommendations include pre-operative chemoradiotherapy or short-course radiotherapy followed by surgery and adjuvant chemotherapy.
- Total mesorectal excision is the standard surgical procedure to completely remove the rectal tumor and lymph nodes.
ROLE OF RADIOTHERAPY AND CHEMOTHERAPY IN CARCINOMA LARYNX1 (1).pptxBrijesh Maheshwari
This document discusses the role of radiotherapy and chemotherapy in treating carcinoma of the larynx. It covers staging of the disease, workup, treatment algorithms, dose prescriptions and management for different stages. Early glottic carcinoma is typically treated with radiotherapy to preserve the voice. Advanced stages may require total laryngectomy with adjuvant chemoradiation. Intensity modulated radiotherapy can help spare nearby organs at risk. Concurrent chemoradiation with cisplatin improves outcomes for advanced stages. Close follow up is needed after treatment to monitor for recurrence.
Further Supporting Evidence to Q4 (Part 2) - Dr MJ Devlinmjdevlin
This document discusses treatment guidelines for lung cancer from NICE. It covers:
- Lung cancer is the most common cancer in the UK, with poor survival rates.
- Treatment options for NSCLC include surgery, chemotherapy, radiotherapy alone or combined. Surgery is recommended for early stage NSCLC when possible.
- Limited stage SCLC is treated with chemotherapy and potentially chemoradiotherapy or surgery. Extensive stage SCLC receives chemotherapy alone or with radiotherapy if a good response.
- Treatment decisions must consider a patient's overall health and fitness as assessed by performance status scales.
This document provides information on testicular cancer, including its incidence, histology, lymph node drainage patterns, staging classifications, workup, and management guidelines. Some key points:
- Testicular cancers constitute 1% of all cancers and germ cell tumors are the most common solid tumors in men aged 15-35.
- Lymph node drainage patterns differ for right and left testes, with retroperitoneal lymph nodes being the most common site of spread.
- Germ cell tumors are the most common type and are classified based on their histologic components.
- Staging involves the TNM classification and serum tumor marker levels. Workup includes imaging, tumor marker tests, and radical orchi
Management of malignant spinal cord compressionShreya Singh
This document summarizes the management of malignant spinal cord compression. It defines MSCC as cancer growth in or near the spine that presses on the spinal cord. Symptoms include back pain, motor deficits, and sensory deficits. Treatment involves corticosteroids, surgery, and radiotherapy. Surgery plus radiotherapy provides better outcomes than radiotherapy alone for patients with good performance status and at least 3 months life expectancy. Standard radiotherapy is 30 Gy in 10 fractions. Shorter courses are used when survival is poor. Surgery may be indicated for instability, intractable pain, or radioresistant cancers.
Rectal carcinoma is primarily treated with surgery involving a total mesorectal excision to achieve negative margins. Neoadjuvant chemoradiation is used to reduce local recurrence risk for transmural or node-positive cancers. Response to neoadjuvant therapy determines prognosis and need for adjuvant treatment, with better response associated with improved outcomes. Adjuvant chemotherapy may improve disease-free survival for stage II-III cancers receiving neoadjuvant chemoradiation and surgery. Surgical options include low anterior resection or abdominoperineal resection. Metastatic disease has a poor prognosis and is evaluated for resectability and treatment with chemotherapy.
Surgery plays an important but limited role in the management of testicular cancer. The main surgical procedures are:
1) Radical high inguinal orchidectomy, which is the primary treatment and provides staging information.
2) Retroperitoneal lymph node dissection (RPLND), which may have a therapeutic, prophylactic, or diagnostic role depending on the stage and histology.
3) In select cases, hemi scrotectomy or metastectomy may be performed. While surgery is crucial for diagnosis and staging, most testicular cancers are highly responsive to chemotherapy and radiotherapy, which are the primary treatment modalities.
1. Locally advanced rectal cancers are defined as T4 or node-positive lesions that cannot be completely resected without a high risk of residual disease. Management involves pre-operative chemotherapy with or without radiation therapy followed by surgery and adjuvant chemotherapy.
2. For resectable stage II/III cancers, pre-operative chemoradiation or radiation followed by surgery and adjuvant chemotherapy improves local control and survival compared to surgery alone.
3. For unresectable T4 cancers, induction chemotherapy and long-course chemoradiation may enable resection. Adjuvant chemotherapy is recommended in all cases.
This document summarizes the debate around providing adjuvant chemotherapy following neoadjuvant chemoradiotherapy for rectal cancer. It outlines the current treatment approaches and evidence for and against adjuvant chemotherapy. Studies have shown conflicting results as to whether adding oxaliplatin to adjuvant chemotherapy improves outcomes. Large trials comparing adjuvant chemotherapy to observation alone did not find significant differences in survival or recurrence, though a meta-analysis found a small improvement in disease-free survival with chemotherapy. The author concludes that for locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy, adjuvant chemotherapy is indicated for high-risk pathologic stage II/III tumors but the benefits are less clear for lower-risk cases.
This presentation covers the guidelines for follow up of patients with Hodgkin's lymphoma after they achieve complete remission and complete their therapy.
This document provides guidance on writing a thesis, including sections to include, formatting, and style. It outlines the typical structure of a thesis as an introduction, literature review, methods, results, discussion, and conclusions. It discusses elements that should be included in each section, such as stating the research question in the introduction and summarizing results in the conclusions. The document also provides examples of formatting requirements for the title page, table of contents, and references. Key recommendations include using the Harvard referencing style and 1.5 line spacing for the English version.
This document provides an overview of referencing and citation styles. It discusses why references are important, the different components of citations and references, and the key styles including alphabetical (e.g. Harvard) and numbered (e.g. Vancouver). The agenda covers citation items like quotations and paraphrasing, categories of styles, examples of references, and referencing software. The goal is to teach researchers how to properly cite sources and format reference lists in manuscripts and protocols.
This is an overview of the adjuvant Tx of pancreatic CA. A Lecture that was given in the annual conference of NCI Egypt: 45 years against cancer in Egypt. Cairo, April, 2013
This document provides an introduction to clinical research and good clinical practice (GCP). It discusses the types of scientific and clinical research, including observational and experimental study designs. The document outlines the phases of clinical trials from I to IV. It emphasizes the importance of ethics in research and describes GCP as international ethical and quality standards for clinical research. GCP aims to protect research participants and ensure valid, reliable results. The document lists the parties involved in clinical research, including investigators, sponsors, and ethics committees, and their roles and responsibilities.
Bone sarcomas are rare cancers that can be curable if treated properly. The main types are osteosarcoma, Ewing sarcoma, and chondrosarcoma. Staging involves imaging and biopsy to determine tumor size, location, and spread. Multidisciplinary teams are needed for optimal care. Chemotherapy is important for osteosarcoma and Ewing sarcoma but not usually effective for chondrosarcoma. Neoadjuvant chemotherapy followed by surgery improves outcomes for osteosarcoma over surgery alone. Short and long chemotherapy regimens appear equally effective for operable osteosarcoma. Ifosfamide added to standard regimens improves outcomes for non-metastatic and
Melanoma arises from neural crest cells that migrate and produce the pigment melanin. It can present in skin or mucosal surfaces and commonly spreads from radial to vertical growth phases as it invades deeper tissues. Treatment depends on tumor stage and characteristics as well as mutation status, and may involve surgery, radiation, immunotherapy, targeted therapy, or chemotherapy.
The study evaluated annual low-dose helical CT screening versus standard chest x-ray for lung cancer screening in high-risk individuals aged 55-74 years who were heavy smokers. Over 53,000 participants were randomized across 33 sites in the U.S. The trial was stopped early based on a recommendation when interim results found a 20% reduction in lung cancer mortality with CT screening. CT screening found more positive cases but also had higher false positive rates compared to chest x-ray.
This document discusses gastric cancer staging, treatment, and clinical trials. It begins with an overview of TNM staging for gastric cancer. The main treatment approaches discussed are surgery, chemotherapy, and chemoradiotherapy in both adjuvant and neoadjuvant settings. Key clinical trials summarized include the MAGIC trial demonstrating improved survival with perioperative chemotherapy and the INT-0116 trial showing benefit of postoperative chemoradiotherapy. Later lines of chemotherapy discussed include regimens using fluoropyrimidines, platinum agents, taxanes, and irinotecan. The ToGA trial established the benefit of adding trastuzumab for HER2-positive gastric cancer.
1) Evaluating scientific literature is important due to the huge volume of new articles published each year. It is necessary to prioritize what to read in order to acquire the most relevant information.
2) There are different types of information sources, including primary sources which are original research articles, secondary sources which discuss primary sources, and tertiary sources which discuss secondary sources.
3) Evidence-based medicine tools like the evidence pyramid and evidence boxes can help evaluate different types of studies and quickly determine the appropriate level of evidence for answering clinical questions.
This document provides information on ovarian cancer including:
1. It describes the TNM staging system for ovarian cancer and defines each stage.
2. It discusses treatment options including surgery, chemotherapy administered intravenously or intraperitoneally, and maintenance therapy.
3. It notes that the standard treatment is intravenous chemotherapy but intraperitoneal chemotherapy may be an option for early stage III disease with residual tumor less than 1cm.
This document discusses the history of medicine from ancient times to the medieval era. It mentions several important figures such as:
- Imhotep in ancient Egypt who practiced surgery, dentistry, and extracted medicine from plants.
- Hippocrates, the father of modern medicine, who established clinical inspection, observation, and documentation as well as the Hippocratic Oath.
- Galen, a physician to the Roman emperor Marcus Aurelius, who performed early animal experiments including spinal cord transection.
- Ibn Sina (Avicenna) who made major contributions to medicine, including establishing experimental medicine.
- Ibn al-Nafis who provided an accurate description of
A 40-year-old male presented with a one-month history of worsening headaches that were unimproved by various treatments. Imaging revealed a 3x3 cm brain mass. The patient's doctor discussed the potential of a brain tumor and the need for biopsy to make a definitive diagnosis. The doctor explained that further testing would be needed to determine if the mass was a primary or secondary brain tumor, the tumor type and grade, and the most appropriate treatment plan based on factors like tumor location, size, the patient's health status, and available therapies. A pathological diagnosis would be essential before considering treatment options like surgery, radiation, chemotherapy, or a combination.
This document provides information about prostate cancer including its anatomy, grading, staging, risk classification, diagnostic workup, and treatment options. It discusses in detail Gleason scoring, TNM staging, factors that determine risk classification as localized, locally advanced, or metastatic disease. Treatment strategies are outlined depending on risk classification, including active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Treatment related side effects and long term outcomes are also summarized.
- Renal cell carcinoma accounts for 2-3% of all malignancies and risk factors include smoking, obesity, and von Hippel-Lindau disease.
- Treatment depends on tumor stage and includes surgery for localized disease and systemic therapies like sunitinib, sorafenib, temsirolimus, bevacizumab, and everolimus for advanced or metastatic disease.
- First line options for metastatic RCC include sunitinib for good-intermediate risk and temsirolimus for poor-risk based on MSKCC criteria; options for refractory disease include sorafenib, everolimus, and sequential targeted therapies.
This document discusses hepatocellular carcinoma (HCC). It outlines the main risk factors for HCC as hepatitis B and C, alcohol, aflatoxin, and certain genetic conditions. It notes that 60-80% of HCC cases occur in patients with cirrhosis. The document discusses screening and diagnosis of HCC using AFP levels and imaging modalities. It covers staging of HCC and describes treatment options including surgery, ablation, embolization, and transplantation.
Cholelithiasis is a common risk factor for gallbladder cancer. Gallbladder cancer often mimics other gallbladder conditions and is frequently diagnosed at an advanced stage. Adenocarcinoma is the most common pathology. Staging involves the TNM system and survival rates vary significantly based on stage - from a median of 12 months for stage 1 to only 1 month for stage 4. Surgery offering curative intent involves cholecystectomy with hepatic resection and lymphadenectomy, while palliative options exist for unresectable or metastatic disease. Adjuvant therapy may involve chemotherapy or chemoradiation depending on risk factors.
2. • US:
• In 2012: 11,280 new cases and 3,900 mortalities
• adults: 1%, pediatrics: 15%
• Egypt:
• GPBCR: adults: 2.5%, pediatrics: 10%
• NCI: adults: 2.8%, pediatrics: 10%
• RT is a risk factor
3. • Most common primary sites
• Extremities (60%),
• Trunk (19%),
• Retroperitoneum (15%)
• Head and neck (9%)
• Most common metastatic sites
• Generally : lungs
• With abdominal tumors: liver and
peritoneum
5. Most common subtypes of STS
• In children:
• Rhabdomyosarcoma
• in adults
• Pleomorphic sarcoma (MFH),
• GIST,
• liposarcoma,
• leiomyosarcoma,
• synovial sarcoma,
• malignant peripheral nerve sheath tumors
6. Molecular Diagnosis of STS
• (i) sarcomas with specific genetic alterations and usually
simple karyotypes (eg, chromosomal translocations or point
mutations); and
• (ii) sarcomas with non-specific genetic alterations and
complex unbalanced karyotypes.
• Methods:
• Conventional cytogenetic analysis,
• Fluorescence in-situ hybridization (FISH) and
• Polymerase chain reaction (PCR)
7. • EWSR1-ATF1 in clear cell sarcoma,
• TLS-CHOP (also known as FUS-DDIT3) in myxoid or round cell
liposarcoma,
• SS18-SSX (SS18-SSX1 or SS18-SSX2) in synovial sarcoma, and
• PAX-FOXO1 (PAX3-FOXO1 or PAX7-FOXO1) in alveolar
rhabdomyosarcoma].
8. Evaluation and Workup
• H&P: for DD
• Lab: limited role
• Bx:
• core or open biopsies by experienced members.
• FNA is generally inadequate
• Radiology:
• Local:
• MRI: most important particularly in extremity STS
• CT: most important particularly in retroperitoneal STS
• Plain XR: optional
• Possible metastatic sites:
• CT Chest: in all cases
• CT Abdomen and pelvis: myxoid round cell liposarcoma, angiosarcoma, leiomyosarcoma or
epithelioid sarcoma
• MRI spine: myxoid round cell liposarcomas
• CT/MRI brain Alveolar soft part sarcoma (ASPS)
• Local and Metastatic sites:
• PET or PET/CT
9. PET or PET/CT in STS
• Values:
• Prognosis and grading:
high SUVmax correlates
with higher tumor grade
and worse survival and
disease progression
• response to chemotherapy for
firm, and deep >3 cm, high-
grade extremity STS:
decrease SUVmax (35-40%
drop particularly after 1st
cycle) correlates with
response, RFS, DFS
10. • T1: <= 5 cm
• A: superficial ( to and not invading superficial fascia)
• Deep ( to or invading superficial fascia)
• T2: > 5 cm
• A: superficial ( to and not invading superficial fascia)
• Deep ( to or invading superficial fascia)
• No T3 or T4
• NB: ovary has no T4
T1 T2 N1 M1
• N1: regional LN (RARE) G1, GX IA IB III IV
• M1: distant mets G2 IIA IIB III IV
G3 IIA III III IV
• Low grade: G1
• High grade: G2,3
• Grade cannot be assessed: GX
11. • Surgery:
• Mainstay
• Problems: recurrence, incomplete resection for difficult sites
• RT:
• May be used pre, intra, or postoperative
• May be used as definitive Tx
• External beam, brachytherapy or radiosurgery
• Systemic therapy:
• May be used ad neoadjuvant or adjuvant
• May be combined with RT
• May be used alone in disseminated disease
• Includes: chemotherapy, targetd therapies
12. • Standard primary treatment for most sarcomas
• Extremity STS
• Limb sparing surgery (LSS) is recommended to preserve function
• Amputation for non-functional limb or infeasible LSS or patient
preference
• If adequate initial surgery cannot be done:
• Preoperative chemo or radio or chemoradio
• To decrease local recurrence
• Chemo or radio can be used (either pre or post)
• Negative SM is always desirable and may need re-resection
• Adjuvant RT in:
• Close SM (<1 cm; R0)
• Microscopic + SM (R1) on bone or major blood vessels
13. compartment resection is
not routinely necessary
• Resect the tumor with appropriate negative margins (>1 cm)
• Close margins (<1 cm) may be necessary to preserve uninvolved
critical neurovascular structures, bones, joints.
14. • Ideally, the biopsy site should be
excised en bloc with the definitive
surgical specimen
• Metalic clips can indicate suspiciuos
margins to help RT
15. Surgical margin (SM) and residual (R)
• Negative SM = R0
• Adequate: >1cm
• Close: < 1cm
• Close margins may be necessary to preserve uninvolved critical
neurovascular structures, bones, joints
• Adj RT is given in close margins
• Positive SM = R1 or R2
• R1 resection - Microscopic residual disease
• R2 resection - Gross residual disease
• surgical re-resection to obtain negative margins should strongly be
considered if it will not have a significant impact upon functionality
• Adj RT is given in microscopically positive margin (R1) on bone, major
blood vessels or a nerve
• Uncertain margin:
• Consult radiotherapist
16. • Because the risk of failure in the
surgical bed can be high, Many
clinicians augment surgery with
RT and chemotherapy, either
preoperatively or postoperatively,
17. • Source:
• EBRT: conventional or IMRT
• Brachytherapy
• Timing
• Preoperative: 50 Gy
• Easier surgery
• Poor wound healing
• Boost if close or positive SM
• Postoperative
• Improve local control in high-grade extremity STS with positive SM or
higher stage (III), old age
• May be partly given immediately (Intraoperative) and completed
later
18. Chemotherapy or chemoradiation
• Preop chemoradiation:
• Value: increase local control, DFS and OS
• CTàRT±CTàSurgery à±CT
• Regimens:
• Doxorubicin (30 mg/m2/d x 3) concurrent with RT (300 cGy x 10)
• IMAP x 2àRT±MAP on rest days (0, 21, 42) àIORT
• MAID+RT (44 GY split)àsurgery àMAID x 3 if SM+
• Preop chemotherapy:
• Value: inconsistent
• CTà surgery à±CT
• Regimens:
• MAID
19. Chemotherapy
• Postop (adjuvant) chemotherapy:
• Value: improve RFS and OS of extremity STS
• EORTC trials lack OS benefit??
• surgery àCT
• Regimens:
• Doxorubicin based (doxo-ifos)
• Epirubicin based (epi-ifo)
• Definitive chemotherapy:
• In advanced, unresectable or metastatic disease
• Single agents: dacarbazine, doxorubicin, epirubicin or ifosfamide,
gemcitabine, docetaxel, vinorelbine, pegylated liposomal
doxorubicin and temozolomide
• Anthracycline-based combination regimens: doxorubicin or
epirubicin with ifosfamide and/or dacarbazine
20. Definitive Chemotherapy/targeted
Therapy
• In:
• advanced, irrresectable or metastatic disease
• Approaches:
• Single agents CT:
• dacarbazine, doxorubicin, epirubicin or ifosfamide,
• gemcitabine, docetaxel, vinorelbine, pegylated liposomal doxorubicin
and temozolomide
• Trabectedin: good RR
• Combinations CT:
• Anthracycline-based combination regimens: first-line
• doxorubicin or epirubicin with ifosfamide and/or dacarbazine
• Non-antracycline combination regimens: after failure of anthracycline
• gemcitabine and docetaxel particulalry in LMS
• Targeted Tx:
• Pazopanib: after failure of doxo-based regimens, Prolongs PFS, No in
liposarcoma
• Ohers: sunitinib, imatinib, crizotinib, sirolimus, avastin
21. Treatment of STS of
extremities and trunk
G Obs Preop Preo Preop Surg Posto Posto Posto
erve RT pCT CRT p RT p CT p CRT
I T1 (small, <5) 1 √ may
T2 (large, >5) 1 √ √
II T1 (small, <5) 2,3 May May √ √ May
T2 (large, >5) 3 May May √ √ √ May
III T2 (large, >5) 3 May May √ √ √ May
N1 May May √+ √ May
Radical LND
IV Limited M1
Dissemin’d May if May MAY May
M1 Sym-
Post op RT if : SM <1cm, non-intact fascial plane
22. Treatment of STS of
retroperitoneum or intra-abdominal
Obs Preop Preo Surg Posto Posto
erve RT pCT p RT p CT
Resectable May May √ ± IORT May May
in R1
or
Boost
Unresectable √ √ √ if becomes resectable
Otherwise as M!
IV Limited M1
Dissemin’d May if May MAY May
M1 Sym-
Post op RT if : SM <1cm, non-intact fascial plane
23. Desmoid Tumors
(Aggressive Fibromatoses)
• Mesenchymal neoplasms
• Well-circumscribed, differentiated fibrous tissue with no
histopathological features of malignancy.
• However, they are often categorized as low-grade sarcomas
• locally destructive and infiltrative but rarely metastasize
• Need extensive surgery
• Tend to recur locally after excision with long natural history
• 10% of patients died of progressive disease.
24. • Abdominal wall of young
pregnant females
• Intra-abdominal
mesenteric masses, and
large extremity masses in
older men and women.
25. • Component of the familial adenomatous polyposis (FAP)
• may also arise through elective surgical intervention (eg,
colectomy) in susceptible patients.
• 85% have mutations in exon 3 of CTNNB1 gene encoding for β
catenin AND this was associated with more recurrences
26. Evaluation and Workup
• H& P
• Exclude Gardner’s syndrome
• Imaging:
• Local: CT or MRI
• Chest
• Biopsy
27. Resectable Tumors Irresectable Tumors
• Observation: • Observation
• small size, asymptomatic, • Definitive RT (54-58 Gy)
favorable sites • No prior RT only
• In extremity, head and neck or
• Surgery: superficial trunk
• Mainstay • Not in retroperitoneal/intra-
abdominal
• Large size, symptomatic, • very slow response (~2ys)
unfavorable sites • Systemic therapies:
• Preop RT or systemic therapy • NSAIDS
may be given • Hormonal therapies
• Postop RT if large tumors or • Biologic therapies
SM+ (R1) • Surgery
• Radical surgery if the above fails
28. Systemic treatment of desmoids
• Indications:
• advanced or unresectable desmoids
• Agents
• NSAIDS: sulindac or celecoxib
• Hormonal: tamoxifen, toremifene
• Biological agents: low-dose interferon
• Chemotherapy: methotrexate and vinblastine, doxorubicin-based
regimens
• tyrosine kinase inhibitors: imatinib and sorafenib
29. Rhabdomyosarcoma (RMS)
• histologic subtypes:
• Embryonal: children
• Alveolar: adolescents
• Pleomorphic: adults and aggressive
• extremities (26%)
• trunk (23%)
• genitourinary tract (17%) and
• head and neck (9%)
31. • VD±C: vincristine and dactinomycin (with or without
cyclophosphamide),
• VAC: vincristine, doxorubicin and cyclophosphamide
• VAC alternating with ifosfamide and etoposide
• HD methotrexate with CNS and leptomeningeal invovlvment
when RT is not feasible
32.
33.
34. Amputation LSS+RT p
Number 16 27 2:1 randomization
Local Recs % 0 4 0.06
DFS% 78 71 0.75
OS% 88% 83% 0.99
Highest recurrence was for SM+
65 patients received postop: Adriamycin, cyclophosphamide, MTX
Chemotherapy No chemotherapy p
3-y DFS% 92 60 0.0008
3y- OS% 95 75 0.04